Treatment options for necrotizing scleritis in rheumatoid arthritis patients.
| Autor: | Kraker, Jessica A., Smith, Wendy M. |
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| Předmět: |
ANTI-inflammatory agents
COMBINATION drug therapy PAIN measurement UVEITIS IMMUNOSUPPRESSIVE agents RHEUMATOID arthritis DISEASE management MYCOPHENOLIC acid SCLERA EYE diseases TREATMENT effectiveness PATIENT care RITUXIMAB IMMUNE system BIOTHERAPY OPERATIVE surgery AUTOIMMUNE diseases INTERLEUKINS THERAPEUTICS DISEASE complications |
| Zdroj: | Expert Review of Ophthalmology; Oct2024, Vol. 19 Issue 5, p357-377, 21p |
| Abstrakt: | Introduction: Necrotizing scleritis is more likely to be associated with severe pain, poor visual outcomes, increased mortality, and autoimmune disease such as rheumatoid arthritis. The advent of targeted biologic therapy has revolutionized the treatment of rheumatic diseases, and these medications are currently being explored for ocular inflammatory disease – including necrotizing scleritis, which is often refractory to conventional immunomodulatory therapies. Areas covered: The authors review available therapies for scleritis, including topical treatments and systemic immunosuppressive agents. Particular attention is given to CD20 inhibitors, TNFα inhibitors, IL6 inhibitors, and IL1 inhibitors as they are increasingly used to treat ocular inflammatory disease. Finally, the authors touch on surgical techniques for reinforcing necrotic areas of sclera. Expert opinion: The authors advocate for a standardized clinical grading system of scleritis to facilitate large scale, multicenter, and randomized clinical trials evaluating the efficacy of treatment regimens for noninfectious scleritis – particularly for TNFα inhibitors, anti-IL6 agents, and combinations of conventional medications. For noninfectious and recalcitrant necrotizing scleritis, the authors recommend initial therapy with mycophenolate mofetil, followed by a TNFα inhibitor or rituximab. As a last resort for severely recalcitrant and/or globe threatening cases, alkylating agents may be necessary. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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